Predictive model of postoperative pneumonia after neoadjuvant immunochemotherapy for esophageal cancer

BackgroundPostoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.MethodWe retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the “glmnet” language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.ResultsTwenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before vs. after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75–0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.ConclusionsOur prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.     

参与救治新发急性呼吸道传染病医护人员心理健康影响因素及应对策略

  目的  分析新疆援鄂抗击新型冠状病毒肺炎医护人员心理健康状况。  方法  2020年1月28日 — 2月29日,新疆援鄂分三批次累计派出386名医护人员。研究以问卷星为载体,采用Zung氏焦虑自评量表（SAS）对调查对象的心理现状进行调查,并与中国常模对比分析。采用一般性统计描述、单因素分析、回归分析方法。  结果  有效调查表361份,有效率93.5 %。新疆援鄂医护人员心理健康程度低于全国常模,主要心境障碍为焦虑,检出焦虑者共285人（78.95 %）：轻度焦虑187人（51.80 %）,中度焦虑87人（24.10 %）,重度焦虑11人（3.05 %）。恐惧评分、隔离区累积工作时长、民族、是否进入隔离区、病房类别,是医护人员心理健康的影响因素（P < 0.05）。  结论  隔离区环境是医护人员产生不同程度心理应激反应的主要原因,隔离区累计工作时长5～8 d者心理健康受影响程度较重,援鄂人员心理受疫情影响总体情况较轻。     

神经再生素对皮层细胞基因表达影响的基因芯片研究

目的：采用基因芯片技术,观察神经再生素对体外培养的胚鼠大脑皮质细胞基因表达的影响。方法：取ICR胚鼠（15d)大脑皮层细胞,无血清培养。实验组加入神经再生素（2μg/ml）,对照组加入等量基础培养液。培养6h后,抽提实验组和对照组皮层细胞总RNA,经反转录分别用Cy5、Cy3荧光标记成cDNA探针。将荧光标记的cDNA与MGEC－40s基因表达谱芯片杂交,芯片扫描、数据处理。结果：实验组与对照组大脑皮质细胞出现64条差异性表达的基因。呈现上调的基因有：钙调素结合蛋白、锌指蛋白激酶、核糖体蛋白等基因;下调基因有：抑制细胞分裂因子等基因。结论：神经再生素可作用于体外培养的胚鼠大脑皮层细胞,从基因调控水平促进脑细胞生长。     

龙胆苦苷在人尿中的含量测定及排泄研究

目的:建立固相萃取液质联用方法测定人尿中龙胆苦苷浓度,研究人体静脉滴注注射用秦龙苦素的主要代谢途径。方法:尿样加入咖啡因内标,经固相萃取后LC-MS/MS分析。色谱条件为:Rescek C8柱(150 mm×2.1 mm,5μm),流动相为:甲醇-10 mmol/L醋酸铵缓冲液-乙腈(50∶40∶10),流速为0.2 mL/min,质谱检测采用多反应离子监测方式。12名健康受试者随机分组交叉静脉滴注80,240,400 mg药物,用本法测定各时段尿样的浓度。结果:龙胆苦苷在30~9 000 ng/mL线性良好(r=0.998 0),回收率为91.10%~96.21%,提取回收率为100.52%~103.83%,高、中、低浓度日内和日间变异系数均小于10%;24 h内3个剂量下原形药物在尿中累积排泄率分别为(76.59±10.02)%、(71.95±12.12)%、(79.76±8.54)%,累积排泄量与给药剂量呈正比,排泄高峰为0~5.5 h。结论:本方法适用于临床药物动力学研究,注射用秦龙苦素在人体内主要是以原形龙胆苦苷经肾脏排泄。     

新疆少数民族在校男护生的专业认同质性研究

[目的]探讨新疆少数民族在校男护生对专业的认同情况.[方法]运用质性访谈和半开放式问卷等研究方法,从专业认同总特征、专业认同的认知、专业认同的情感态度和专业认同的未来预期等方面对新疆少数民族在校男护生的专业认同情况进行调查.[结果]男护生对专业的认同归因情况：①外部原因的矛盾性,既迫于就业压力认同护理专业,又由于民族传统文化男性角色的定位排斥护理专业;②内部原因的复杂性,选择护理专业时的被动性和盲目性、传统文化产生的专业认同性别差异以及自身个性差异等因素交互影响.[结论]护理教育应重视男护生的专业认同.